Unequal care, unequal health care? Gender differences in health care use after adult care access

Wang, Wanying and Costa-Font, Joan ORCID: 0000-0001-7174-7919 (2025) Unequal care, unequal health care? Gender differences in health care use after adult care access. Social Science & Medicine. ISSN 0277-9536 (In Press)

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Abstract

Access to care among older adults can reveal unmet health needs, though in some cases it may substitute for other forms of health care. We argue that the balance between these effects is largely gender dependent: female spouses are more likely to act as informal caregivers and, as a result, may have neglected their own health needs. To examine this issue, we exploit the variation introduced by Scotland’s Free Personal Care (FPC) program, a government initiative implemented in 2002 that provides free personal care access to all eligible individuals regardless of income. Using a Difference-in-Differences (DiD) framework comparing Scotland with the rest of the United Kingdom and a rich longitudinal dataset of men and women aged 65 and over, we find that FPC significantly increased the uptake of home help services among women, with little change among men. Among women, this expansion in care access had a complementary effect, leading to a 3.5–percentage-point rise in inpatient admissions, whereas among men, the evidence suggests a modest substitution effect. The effects are strongest among older adults who live alone, face socioeconomic disadvantage, or have high care needs.

Item Type:	Article
Additional Information:	© 2026 The Author(s)
Divisions:	Health Policy
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine H Social Sciences > HV Social pathology. Social and public welfare. Criminology
JEL classification:	I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy; Regulation; Public Health J - Labor and Demographic Economics > J1 - Demographic Economics > J14 - Economics of the Elderly; Economics of the Handicapped H - Public Economics > H7 - State and Local Government; Intergovernmental Relations > H75 - State and Local Government: Health, Education, and Welfare
Date Deposited:	21 Nov 2025 16:48
Last Modified:	27 Nov 2025 10:21
URI:	http://eprints.lse.ac.uk/id/eprint/130287

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